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Scandinavian Journal of Trauma,... May 2016Pelvic fractures might carry a significant risk of bleeding. A wide variety of pelvic binders together with pelvic sheets are available and offer an adjunct to the... (Review)
Review
INTRODUCTION
Pelvic fractures might carry a significant risk of bleeding. A wide variety of pelvic binders together with pelvic sheets are available and offer an adjunct to the initial management of poly-trauma patients with pelvic injuries. These devices are collectively referred to as pelvic circumferential compression devices (PCCDs). The aim of this study was to review the literature for evidence pertinent to the efficacy and safety of PCCDs.
METHODS
Using the PRISMA guidelines a systematic search on PubMed, Web of Science, CINAHL, Embase and Scopus was carried out. Articles included were in English language and published between 1999 and 2015. Studies included were appraised with narrative data synthesis.
RESULTS
Seven articles addressed mechanical properties of non-invasive external mechanical devices, six articles focused on physiological aspects, and three studies evaluated the pressure characteristics of these devices. We found 4 case reports regarding adverse effects. None of the studies identified addressed the cost effectiveness or pain relief issues related to the use of PCCDs.
CONCLUSIONS
Based on available literature, PCCDs are widely used in the initial management of patients with suspected pelvic bleeding. There is evidence to suggest that external compression reduces disrupted pelvic rings. There are some complications reported following application of PCCDs. Hemorrhagic source and physiological effectiveness of PCCDs needs to be addressed in future studies. In the meantime judicious application of PCCDs will continue to be recommended.
Topics: Fracture Fixation; Fractures, Bone; Humans; Pelvic Bones; Pressure
PubMed: 27193135
DOI: 10.1186/s13049-016-0259-7 -
The Bone & Joint Journal Oct 2018The purpose of this study was to evaluate spinopelvic mechanics from standing and sitting positions in subjects with and without femoroacetabular impingement (FAI). We...
AIMS
The purpose of this study was to evaluate spinopelvic mechanics from standing and sitting positions in subjects with and without femoroacetabular impingement (FAI). We hypothesize that FAI patients will experience less flexion at the lumbar spine and more flexion at the hip whilst changing from standing to sitting positions than subjects without FAI. This increase in hip flexion may contribute to symptomatology in FAI.
PATIENTS AND METHODS
Male subjects were prospectively enrolled to the study (n = 20). Mean age was 31 years old (22 to 41). All underwent clinical examination, plain radiographs, and dynamic imaging using EOS. Subjects were categorized into three groups: non-FAI (no radiographic or clinical FAI or pain), asymptomatic FAI (radiographic and clinical FAI but no pain), and symptomatic FAI (patients with both pain and radiographic FAI). FAI was defined as internal rotation less than 15° and alpha angle greater than 60°. Subjects underwent standing and sitting radiographs in order to measure spine and femoroacetabular flexion.
RESULTS
Compared with non-FAI controls, symptomatic patients with FAI had less flexion at the spine (mean 22°, sd 12°, vs mean 35°, sd 8°; p = 0.04) and more at the hip (mean 72°, sd 6°, vs mean 62°, sd 8°; p = 0.047). Subjects with asymptomatic FAI had more spine flexion and similar hip flexion when compared to symptomatic FAI patients. Both FAI groups also sat with more anterior pelvic tilt than control patients. There were no differences in standing alignment among groups.
CONCLUSION
Symptomatic patients with FAI require more flexion at the hip to achieve sitting position due to their inability to compensate through the lumbar spine. With limited spine flexion, FAI patients sit with more anterior pelvic tilt, which may lead to impingement between the acetabulum and proximal femur. Differences in spinopelvic mechanics between FAI and non-FAI patients may contribute to the progression of FAI symptoms. Cite this article: Bone Joint J 2018;100-B:1275-9.
Topics: Adolescent; Adult; Biomechanical Phenomena; Case-Control Studies; Femoracetabular Impingement; Humans; Lordosis; Lumbar Vertebrae; Male; Pelvic Bones; Posture; Prospective Studies; Radiography; Range of Motion, Articular; Young Adult
PubMed: 30295531
DOI: 10.1302/0301-620X.100B10.BJJ-2018-0060.R1 -
Joint Diseases and Related Surgery 2022This study aims to evaluate survival of patients and implants, functions, and morbidity of surgical technique of reconstruction with a fresh-frozen massive pelvic...
OBJECTIVES
This study aims to evaluate survival of patients and implants, functions, and morbidity of surgical technique of reconstruction with a fresh-frozen massive pelvic allograft following a pelvic resection.
PATIENTS AND METHODS
Between January 2009 and December 2016, a total of 19 patients (12 males, 7 females; mean age: 35.8±14.4 years; range, 10 to 53 years) who underwent reconstruction with fresh-frozen massive allograft after internal hemipelvectomy were retrospectively analyzed. Patients̓ age, sex, resection types, histopathology and grades, surgical margins, operative times, intraoperative blood loss, complications experienced during their treatment (infection, dislocation, implant failure, nonunion, local recurrence and metastasis), neoadjuvant and adjuvant therapies they received, and functional scores were revealed and analyzed in 10 years period.
RESULTS
According to the Enneking and Dunham classification, two (10%) patients had type I resection only, six (32%) had type I-II, one (5%) had a type II resection, one (5%) had type II-III resection, three (16%) had type I-II-III resection, one (5%) had type I-IV resection, and five (26%) had type I-II-IV resection. The resection involved the acetabulum (type II) in all, but three patients. Several complications were seen in 12 patients, although seven patients had no complication. Pelvic resections had a high mortality rate in patients with malignant tumors and reconstruction with massive allograft had a high morbidity rate with susceptibility to many complications. Prolonged surgical time was found to be directly related to blood loss. Deep infection significantly worsened functional results.
CONCLUSION
Despite the high complication rates seen in pelvic resections, massive pelvic allografts represent a valid option for reconstruction after resection of pelvic tumors, but due to the associated morbidity, patients should be carefully selected.
Topics: Adult; Allografts; Bone Neoplasms; Female; Humans; Male; Middle Aged; Pelvic Bones; Retrospective Studies; Treatment Outcome; Young Adult
PubMed: 35361086
DOI: 10.52312/jdrs.2022.344 -
BMC Musculoskeletal Disorders Jun 2021Although the incidence, types, and radiological outcomes of simultaneous ipsilateral pelvic ring and acetabular fractures have been reported, there have been no reports...
BACKGROUND
Although the incidence, types, and radiological outcomes of simultaneous ipsilateral pelvic ring and acetabular fractures have been reported, there have been no reports on factors that may affect the quality of acetabular fracture reduction. Here, we evaluate the radiological outcomes of patients treated for simultaneous ipsilateral pelvic and acetabular fractures and analyze the factors that affect the quality of acetabular fracture reduction.
METHODS
We conducted a retrospective review of patients treated for simultaneous ipsilateral pelvic ring and acetabular fractures between 2016 and 2020. Factors that may predict inadequate reduction of the acetabular fracture were analyzed.
RESULTS
Data from 27 hips of 26 patients were collected. AO B2.2 and anterior columnar fractures were the most common types of pelvic ring and acetabular fractures, respectively. Univariate analysis revealed that Matta's criteria for pelvic ring fracture may be useful for predicting fair to poor quality of acetabular fracture reduction on X-rays. Furthermore, associated fractures identified by Letournel's classification system on computed tomography may be predictive of greater step-offs.
CONCLUSIONS
Associated fractures identified via Letournel's classification may contribute to inadequate reduction of acetabular fractures. Matta's criteria for pelvic ring fractures may also be useful for predicting the risk of inadequate reduction of the acetabulum on X-ray scans. These findings may be assessed intraoperatively by fluoroscopy before beginning osteosynthesis for acetabular fractures.
Topics: Acetabulum; Fracture Fixation, Internal; Fractures, Bone; Hip Fractures; Humans; Pelvic Bones; Retrospective Studies
PubMed: 34126982
DOI: 10.1186/s12891-021-04441-z -
Journal of Orthopaedic Surgery and... Oct 2020Hydatid disease (HD) is a zoonotic parasitic disease caused by the larvae of Echinococcus, It is mainly prevalent in pastoral areas. Bone echinococcosis is rare,...
BACKGROUND
Hydatid disease (HD) is a zoonotic parasitic disease caused by the larvae of Echinococcus, It is mainly prevalent in pastoral areas. Bone echinococcosis is rare, accounting for 0.5 to 4.0% of all echinococcosis. It is likely to miss the diagnosis and misdiagnose due to non-specific early symptoms and the clinical manifestations and imaging features. The clinical data of 15 patients with pelvic cystic echinococcosis were analyzed retrospectively, and the X-ray, CT, and MRI imaging features of the disease were discussed, which are reported below.
METHODS
All 15 patients underwent CT scan evaluation. A total of 8 patients underwent coronal, sagittal, and three-dimensional reconstruction with 3-mm-slice thickness, and 4 patients underwent X-ray plain film examination. Five cases underwent MRI scan. Eight cases underwent MRI or CT enhanced scan.
RESULTS
X-ray plain film is characterized by continuous cystic bone destruction, irregular low-density shadow when invading soft tissue, and sometimes calcification which can be seen on the wall or inside the cyst. The involved sacroiliac joint or hip joint may narrow or disappear. The involvement of pelvic cystic echinococcosis is relatively wide, and 80% of patients with pelvic cysts in this group had multiple lesions in the same period. Cystic expansive bone destruction was the most common. Pelvic CT revealed a lobulated hypodense lesion of varying size with internal septae, causing cortical thinning and destruction. Most of them had no periosteal reaction. The iliopsoas muscle is most easily invaded. Single cystic echinococcosis of pelvis showed intermediate or low signal intensity on T1-weighted images and hyperintensity on T2-weighted images in the involved bone and surrounding soft tissue on MRI, and the cyst wall showed linear low signal in T1WI, T2WI, and STIR sequences. The polycystic type is characterized by multiple cysts of varying signal intensity (daughter cysts) within a larger cyst is the typical MRI finding, forming "small vesicles" high signal daughter cysts. Osteosclerosis or calcification showed low signal in T1WI and T2WI.
CONCLUSIONS
The results of this study suggest that the lesions of pelvic cystic echinococcosis are mostly cystic expansive and osteolytic bone destruction, which is easy to invade the surrounding soft tissue, often accompanied with calcification; among them, multiple cystic lesions are characteristic.
Topics: Adult; Bone Diseases, Infectious; Diagnosis, Differential; Echinococcosis; Female; Humans; Magnetic Resonance Imaging; Male; Middle Aged; Multimodal Imaging; Pelvic Bones; Tomography, X-Ray Computed; Young Adult
PubMed: 33106164
DOI: 10.1186/s13018-020-01912-2 -
Cardiovascular and Interventional... Jan 2019Pelvic fractures are potentially life-threatening injuries with high mortality rates, mainly due to intractable pelvic arterial bleeding. However, concomitant injuries...
Pelvic fractures are potentially life-threatening injuries with high mortality rates, mainly due to intractable pelvic arterial bleeding. However, concomitant injuries are frequent and may also be the cause of significant blood loss. As treatment varies depending on location and type of hemorrhage, timely imaging is of critical importance. Contrast-enhanced CT offers fast and detailed information on location and type of bleeding. Angiography with embolization for pelvic fracture hemorrhage, particularly when performed early, has shown high success rates as well as low complication rates and is currently accepted as the first method of bleeding control in pelvic fracture-related arterial hemorrhage. In the current review imaging workup, patient selection, technique, results and complications of pelvic embolization are described.
Topics: Adult; Angiography; Embolization, Therapeutic; Female; Fractures, Bone; Guideline Adherence; Hemorrhage; Humans; Male; Middle Aged; Patient Selection; Pelvic Bones; Tomography, X-Ray Computed
PubMed: 30225676
DOI: 10.1007/s00270-018-2071-4 -
World Journal of Surgical Oncology Nov 2016Complete resection of pelvic bone tumors, especially recurrent and metastatic ones, is often impossible to achieve using conventional surgery. This study aimed to assess...
BACKGROUND
Complete resection of pelvic bone tumors, especially recurrent and metastatic ones, is often impossible to achieve using conventional surgery. This study aimed to assess the benefits and adverse effects of computed tomography (CT)-guided radioiodine (I) brachytherapy for inoperable recurrent and metastatic bone tumors of the pelvis.
METHODS
This was a retrospective study of 22 patients with confirmed pelvic bone tumors (10 females and 12 males; 15-84 years; 21 with primary pelvic tumor and one with pelvic metastasis). CT-guided I brachytherapy was performed using 9-21 I seeds (radioactivity of 0.5-0.7 mCi). Seed implantation was validated by postoperative CT scanning. Complications, pain, survival, and CT-estimated tumor size were carried out to evaluate the therapeutic benefits.
RESULTS
Postoperative CT scans revealed satisfactory I seed implantation, and the radiation dose delivered to 90% of the target area (D90) was higher than the prescription dose (PD). No obvious complications were observed. Pain was reported by 19 of 22 patients, but 17 reported pain relief after implantation. Follow-up ranged 8-27 (median, 19) months. Tumor size was reduced in 11 patients within 1 month after surgery, nine patients showed no change, and tumor size increased in two patients. Finally, 1- and 2-year survival was 81.8 and 45.5%, respectively; 1- and 2-year local tumor control rates were 59.1 and 36.4%, respectively.
CONCLUSIONS
I seed implantation significantly reduced bone tumor size and relieved pain, with a low complication rate. These findings suggest that I brachytherapy treatment could be a useful palliative approach for pelvic bone tumor treatment.
Topics: Adolescent; Adult; Aged; Aged, 80 and over; Bone Neoplasms; Brachytherapy; Cancer Pain; Female; Humans; Iodine Radioisotopes; Male; Middle Aged; Neoplasm Recurrence, Local; Pain Measurement; Palliative Care; Pelvic Bones; Radiation Dosage; Radiotherapy, Computer-Assisted; Radiotherapy, Image-Guided; Retrospective Studies; Tomography, X-Ray Computed; Treatment Outcome; Young Adult
PubMed: 27884196
DOI: 10.1186/s12957-016-1050-y -
The Kobe Journal of Medical Sciences Dec 2018Coxal bone paticipates in the formation of the pelvic skeleton. Anatomy knowledge on coxafemoral joint as well as careful history taking and physical examination are...
OBJECTIVES
Coxal bone paticipates in the formation of the pelvic skeleton. Anatomy knowledge on coxafemoral joint as well as careful history taking and physical examination are crucial in evaluation and management of disorders involving hip joint. The aims of the present study were to perform morphometric measurements of the human coxal bones, calculation of their articular surface areas and report the range of these parameters regarding Turkish adult population.
METHODS
Seventy-two dry human adult coxal bones (39 left and 33 right) from the Anatomy Departments of Erciyes University, Inonu University and Kahramanmaras Sutcu Imam University were measured using a caliper sensitive to 0.1 mm. Morphometric measurements were performed through 22 parameters determined. While 19 of these parameters were related to the distance between two points and thicknesses in various parts of the bone, the remaining three were related to the determination of articular surface areas. The articular surface areas of hip bone (facies auricularis (FA), facies lunata (FL) and facies symphsialis (FS)) were calculated with ImageJ software program.
RESULTS
The average values of facies auricularis area were 1659.04 ± 470.92 mm² and 1637.32 ± 460.15 mm² on the left and right coxal bones, respectively. No statistically significant difference was determined between the left and right coxal bone measurements (p > 0.05). We found a positive and significant correlation between articular surface areas of facies auricularis (FA), facies lunata (FL) and facies symphysialis (FS) and maximum width of ilium (rFA = 0.299, rFL = 0.276, rFS = 0.375, respectively and p < 0.05), and distance between spina ilica anterior superior and the upper edge of facies symphysialis (rFA = 0.268, rFL = 0.511, rFS = 0.482, respectively and p < 0.05).
CONCLUSION
The distribution and mean values of coxal bone morphometric measurements usually differ between individuals and human populations. With this regard, orthopedic surgeons should be aware of the diversity in components of coxal bone dimensions although implants and hip prosthesis components of different sizes are manufactured. Safe routes and estimated distances should be considered during surgical procedures to avoid complications.
Topics: Adult; Anthropometry; Humans; Pelvic Bones; Reference Values; Turkey
PubMed: 30728341
DOI: No ID Found -
World Journal of Emergency Surgery :... Aug 2021Patients with pelvic and/or acetabular fractures are at high risk of developing thromboembolic (TE) complications. In our study we investigate TE complications and the...
BACKGROUND
Patients with pelvic and/or acetabular fractures are at high risk of developing thromboembolic (TE) complications. In our study we investigate TE complications and the potential negative effects of concomitant pelvic or acetabular injuries in multiple injured patients according to pelvic/acetabular injury severity and fracture classification.
METHODS
The TraumaRegister DGU® was analyzed between 2010 and 2019. Multiple injured patients with pelvic and/or acetabular fractures with ISS ≥ 16 suffering from TE complications were identified. We conducted a univariate and multivariate analysis with TE events as independent variable to examine potential risk factors and contributing factors.
RESULTS
10.634 patients met our inclusion criteria. The overall TE incidence was 4.9%. Independent risk factors for the development of TE complications were sepsis, ≥ 10 operative interventions, mass transfusion (≥ 10 PRBCs), age ≥ 65 years and AIS ≥ 3 (all p < 0.001). No correlation was found for overall injury severity (ISS), moderate traumatic brain injury, additional injury to lower extremities, type B and C pelvic fracture according to Tile/AO/OTA and closed or open acetabular fracture.
CONCLUSIONS
Multiple injured patients suffering from pelvic and/or acetabular fractures are at high risk of developing thromboembolic complications. Independent risk factors for the development of thromboembolic events in our study cohort were age ≥ 65 years, mass transfusion, AIS ≥ 3, sepsis and ≥ 10 surgery procedures. Among multiple injured patients with acetabular or pelvic injuries the severity of these injuries seems to have no further impact on thromboembolic risk. Our study, however, highlights the major impact of early hemorrhage and septic complications on thromboembolic risk in severely injured trauma patients. This may lead to individualized screening examinations and a patient-tailored thromboprophylaxis in high-risk patients for TE. Furthermore, the number of surgical interventions should be minimized in these patients to reduce thromboembolic risk.
Topics: Acetabulum; Female; Fractures, Bone; Humans; Incidence; Injury Severity Score; Male; Middle Aged; Multiple Trauma; Pelvic Bones; Registries; Risk Factors; Thromboembolism
PubMed: 34446032
DOI: 10.1186/s13017-021-00388-7 -
European Journal of Trauma and... Feb 2023Paediatric pelvic fractures (PPFs) are uncommon but signify serious trauma. A comprehensive multidisciplinary approach is needed due to a high number of associated...
INTRODUCTION
Paediatric pelvic fractures (PPFs) are uncommon but signify serious trauma. A comprehensive multidisciplinary approach is needed due to a high number of associated injuries. This study aims to retrospectively analyse PPFs over a 5-year period and evaluate how advancing skeletal maturity changes fracture patterns and management plans.
METHODS
The trauma database was retrospectively reviewed for pelvic fractures in patients aged ≤ 18 years. Radiographs and CT scans were used to classify pelvic injuries according to the modified Torode classification and determine the status of the triradiate cartilage (open: skeletally immature; closed: skeletally mature). Data collected also included the mechanism of injury, clinical and functional outcomes, and associated injuries. Logistic regression analysis was performed to identify risk factors for associated abdominal injuries.
RESULTS
65 PPFs (2.8% of paediatric trauma admissions during the study period) were classified as type I (3.1%), type II (7.7%), type IIIa (32.3%), type IIIb (38.5%), type IV (18.5%) according to the modified Torode classification. The mean age was 13.41 ± 3.82. Skeletally immature children were more likely to be hit by a motor vehicle as a pedestrian (p < 0.001), be intubated (p = 0.009), acquire Torode type II (p = 0.047) and rami fractures (p = 0.037), and receive chest (p = 0.005) and head injuries (p = 0.046). Skeletally immature children were also less likely to acquire Torode type IV fractures (p = 0.018), receive surgical treatment for their pelvic injuries (p = 0.036), and had a faster time to full weight bearing (p = 0.013). Pelvis AIS score ≥ 4 (OR 5.3; 95% CI 1.3-22.6; p = 0.023) and a pedestrian accident (OR 4.9; 95% CI 1.2-20.7; p = 0.030) were risk factors for associated abdominal injuries. There was a strong association between a higher pelvic fracture grade and the proportion of patients with closed triradiate cartilage (p = 0.036), hospital length of stay (p = 0.034), mean pelvic AIS score (p = 0.039), a pelvis AIS score of ≥ 4 (p = 0.022), mean ISS (p = 0.003), an ISS score between 25 and 75 (p = 0.004), average time to FWB (p = 0.001), requirement of blood products (p = 0.015), and a motor vehicle accident (p = 0.037).
CONCLUSION
PPFs occurring in skeletally mature and immature patients are significantly different in terms of mechanism of injury, fracture severity, fracture pattern, and management strategy. There is a high rate of associated injuries, necessitating an integrated multidisciplinary approach in paediatric trauma centres.
Topics: Child; Humans; Adolescent; Retrospective Studies; Multiple Trauma; Fractures, Bone; Pelvic Bones; Abdominal Injuries
PubMed: 36190546
DOI: 10.1007/s00068-022-02108-5